THE EFFECT OF FRESH FROZEN PLASMA TRANSFUSION ON INTERNATIONAL NORMALIZED RATIO IN EMERGENCY DEPARTMENT PATIENTS

Background: There are few studies researching the effect of fresh frozen plasma (FFP) transfusion on international normalized ratio (INR) in patients with coagulation abnormality. Objective: This study's aim was to determine the effect of FFP transfusion on INR as calculated pretransfusion. In addition, patients were grouped according to pretransfusion INR to determine the improvement in INR per unit of FFP. Methods: Adult patients who had been admitted to our Emergency Department (ED) with coagulation abnormality and received an FFP transfusion, and had pre-and posttransfusion coagulation tests performed, were included in the study. Patients were categorized into five groups according to their pretransfusion INR levels. Improvement in INR per unit of FFP-transfused values (Delta INR (1 unit FFP)) was determined for each group. Results: Eighty-seven patients were entered into the study, and were administered a total of 199 units of FFP. Delta INR (1 unit FFP) value was 0.03 +/- 0.13 for patients whose pretransfusion INR level was under 2; 0.77 +/- 0.47 for those between 2 and 5; 2.14 +/- 0.63 for those between 5 and 9; 3.34 +/- 0.89 for those between 9 and 12; and 4.63 +/- 1.99 for those over 12. A very strong positive correlation was found between pretransfusion INR and Delta INR (1 unit FFP) (p < 0.001, r = 0.957). Conclusion: A significant improvement in INR was observed in patients with higher pretransfusion INR. While determining FFP dose for patients admitted to the ED due to coagulation defect, pretransfusion INR value should be taken into account. (C) 2014 Elsevier Inc

Retrograde cerebral air embolism

Pneumocephalus is a clinical condition caused by dysbarism, trauma, and iatrogenic causes. The most common iatrogenic causes of pneumocephalus are major interventions as a neurosurgery and cardiovascular operations, endoscopy, and minor interventions as a peripheral and central venous access. Especially during insertion of central venous line and intravenous drug and fluid infusion, the venous air embolism may occur in emergency department. In these patients, retrograde pneumocephalus occurs as a result of the air entering the right atrium to the brain. Clinical effects of the air delivery rates are known to be more specific than the total amount of air. In general, intravenous administration of 300 to 500 mL air in the speed of 100mL/min is considered to be lethal. Large amounts of air embolism can cause hypotension and acute circulatory collapse with intracardiac obstruction. The most common symptoms of venous air embolism are anxiety, dyspnea, chest pain, cyanosis, tachycardia, tachypnea, headache, confusion, agitation, syncope, slurred speech, blurred vision, seizures, and ataxia. The mortality of pneumocephalus caused by central venous catheters in patients presented with symptoms of focal neurologic was 8%, whereas the mortality of pneumocephalus in patients presented with encephalopathy was 36%. In our report, a case of pneumocephalus secondary to disconnection of catheter cap in chronic renal failure patient who has hemodialysis via catheter has been presented

Axillary artery laceration after anterior shoulder dislocation reduction

Introduction: Glenohumeral dislocation is the most commonly encountered dislocation in the emergency department. The most frequent complications of glenohumeral dislocation are rotator cuff tears and an increase in the risk of recurrent dislocation. Less common acute complications include fractures, neurological complications and vascular injuries. The incidence of axillary artery injury associated with shoulder dislocation is reported to be about 1–2%. Case: An 81-year-old male presented to the emergency department with pain in the right shoulder after a fall. On physical examination, the shoulder was in slight abduction and external rotation. Shoulder movements were painful and there was a swelling in the axillary region which was tender to palpation. There was no sensory or motor deficit and the peripheral pulses were equal and palpable. Following the administration of analgesics, shoulder reduction was performed using the flexion-adduction-external rotation method. After reduction, the patient started complaining of axillary pain. On control examination, the patient did not have any motor or sensory deficits, but peripheral pulses were not palpable on the right arm. The right upper extremity computed tomography angiography, which was performed with the suspicion of vascular injury, revealed a right axillary artery rupture. Conclusion: Axillary artery injury accompanying anterior shoulder dislocation is a rare but serious condition which may result in limb loss and death. Keywords: Shoulder dislocation, Axillary artery injury, Reduction, Emergency departmen

Residents’ Perceptions of Sustainable Tourism Destination Recovery: The Case of Northern Cyprus

As nations and tourism destinations are beginning to relax nonpharmaceutical measures for the prevention of the COVID-19 virus, a major quest of tourism stakeholders is to restart and restore the once viable and productive industry to its prior state. While the urge to restart and restore may necessitate a strategic plan and drastic measures, care must be taken not to undermine the sustainability of the destination. The current study seeks to understand the perceptions of residents of Northern Cyprus as key tourism stakeholders concerning the impacts of COVID-19 to the island’s tourism activities and recommendations for recovery post pandemic. To this end, the study used grounded theory and semistructured interviews to explore how residents perceive the contribution of focused advertisements and stakeholder engagement in the sustainable restoration of tourism activities post COVID-19 on the island. While divergent opinions were gathered, it can be inferred that stakeholders expect the implementation of strategic plans aided by focused advertisements to ensure the sustainability of their tourist destinations. Policy directions and academic contributions are also stated as requirements

The diagnostic value of complete blood count parameters in patients with subarachnoid hemorrhage

Objectives: Diagnosis of subarachnoid hemorrhage (SAH) in patients presenting with headache is challenging and there has been any biomarker studied for excluding of SAH in those patients. We aim to determine the sensitivity of leukocytosis or left shift to exclude the diagnosis of SAH in ED patients presenting with headache. Method: Adult patients with headache who received a computed tomography (CT) with the diagnosis of SAH and had a complete blood count (CBC) represent the case group, headache patients with normal CT and had a CBC represent the control group. The white blood cell (WBC) count and percentage of polymorphonuclear cells (PMNs%) taken during admission and within the first 6 and 12 h of admission were recorded. Results: A hundred ninety seven patients with SAH and 197 patients without SAH were enrolled in to study. Sensitivity, specificity, NPV and PPV of leukocytosis or increase in PMNs% (left shift) in the diagnosis of SAH was 89.8% (84.5â93.5, 95% CI), 46.7% (39.6â53.9, 95% CI), 82.1% (73.5â88.4, 95% CI) and 62.8% (56.8â68.4, 95% CI) respectively on initial emergency department (ED) admission. Conclusion: CBC should be considered as a noninvasive test for the exclusion of SAH in ED patients with 6 h observation. Keywords: Complete blood count, Subarachnoid hemorrhage, Emergency medicin

Accuracy of bedside ultrasonography for the diagnosis of finger fractures

Objective: Diagnosis of bone fractures by ultrasonography is becoming increasingly popular in emergency medicine practice. We aimed to determine the diagnostic sensitivity and specificity of point-of-care ultrasonography (PoCUS) compared with plain radiographs in proximal and middle phalanx fractures

A rare presentation of Susac syndrome: Report of three pediatric cases

Susac syndrome is a rare disorder that is clinically characterized by encephalopathy, retinopathy and hearing loss. Most of the reported cases in the literature are adult patients, pediatric presentation is extremely rare. Here we present three pediatric patients aged between 10-15; diagnosed as Susac syndrome. They all had thalamic involvement in addition to typical callosal lesions. All of the three patients had a monophasic course and good treatment response